HEALTH Volume 10 • No. 1
Bart Asner, MD: CAPG Members Can Bring Positive Change to Healthcare, p.12 10th Annual Standards of Excellence™ Supports Care Transformation, p.24 Fast Tracking EvidenceBased Medicine to Improve Patient Care, p.26
Spring 2016
Confidence The feeling you have when you are affiliated with Hill Physicians. Lyra Ng, M.D.
Hill Physicians provider since 2011. Uses Ascender preventive care reminders and Hill inSite to review eClaims and eligibility.
At Hill Physicians, we continue to improve upon coordinated care, with remarkable results. We provide the tools and support that practices need to be financially successful and improve the coordinated care experience for their patients. Our advantages include: • Fast, accurate claims payments • Free eReferrals and online doctor-patient communications • Experienced RN case management for complex, time-intensive cases • Deep discounts on EPM and EHR solutions to help you meet the federal mandate • Easy preventive care and disease management reminders for patients • Extensive health resources that boost patient engagement • High consumer awareness that builds practice volume That’s why 3,800 independent primary care physicians, specialists and healthcare professionals have joined Hill. Feel confident in the future of your practice and your patients by affiliating with Hill Physicians Medical Group.
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The Impact of
The numbers may surprise you, but the most important number of all is one. It’s our commitment to caring for our community one patient at a time. From our top ranked hospitals to our vibrant and growing primary care network, UCLA is world-renowned but focused right here at home. It’s a commitment we can all count on.
1-800-UCLA-MD1 (1-800-825-2631)
uclahealth.org
uclahealth.org/getsocial
Over
30
years of
managed care experience
1,200 150 40
physicians
Over
community offices
Over
primary care offices
Patients enter our community offices
2.5 million times each year Santa Clarita
N
Simi Valley 118
map not to scale
Porter Ranch
23
210
Northridge
Thousand Oaks
Panorama City
5
170
Burbank
2
Pasadena
134
101
Westlake Village
Arcadia
405
101
Pacific Palisades
Alhambra
Westwood
Brentwood Malibu
Santa Monica
10
Century City West Los Angeles Marina del Rey
10
90
60
605
5
110 405
710 105
Manhattan Beach Redondo Beach
91
Torrance
Palos Verdes
Fountain Valley Irvine
TABLE OF CONTENTS
ON THE COVER
12
Bart Asner, MD: CAPG Members Can Bring Positive Change to the Healthcare System HEALTH Publisher
Valerie Okunami Editor-in-Chief
Don Crane
DEPARTMENTS
FEATURES
7
16
Notes from the President
2016 CAPG Compensation and
Editorial Advisory Board
Lura Hawkins, MBA Amy Nguyen Howell, MD, MBA Mary Kay Payne, Arch Health Partners Managing Editor
8 Names in the News
Daryn Kobata
10
Editorial Assistant
Nelson Maldonado Contributing Writers
Bart Asner, MD Bill Barcellona Tawnya Bosko, DHA, MS, MHA, MSHL Megan Calhoun, MS, MSW Ken Cohen, MD Don Crane Valerie Green-Amos, MD Amy Nguyen Howell, MD, MBA Stephen J. Linesch, MBA Mara McDermott William Wulf, MD CAPG Health Magazine is published by
Valerie Okunami Media PO Box 674, Sloughhouse, CA 95683 Phone 916.761.1853
Upcoming Events
14 Policy Briefing: Integrated Care for the Sickest of the Sick
18 Federal Legislative Update: CAPG Calls for Inclusion of Medicare Advantage in Delivery System Reform
Please send press releases and editorial inquiries to capghealth@capg.org or c/o CAPG Health, 915 Wilshire Blvd., Suite 1620, Los Angeles, CA 90017
22
Subscription rates: $32 per year; $58 two years; $3 single copy. Advertising rates on request. Bulk third class mail paid in Jefferson City, MO Every precaution is taken to ensure the accuracy of the articles published in CAPG Health Magazine. Opinions expressed or facts supplied by its authors are not the responsibility of CAPG Health Magazine. Š 2015, CAPG Health Magazine. All rights reserved. Reproduction in whole or in part without written permission is strictly prohibited.
6 l CAPG HEALTH
Spring 2016
20 Homebound Health for a Unique Population
24 10th Annual Standards of Excellence
26 Bench to Bedside: Fast Tracking
capghealth.com
For advertising, please send email to vokunami@netscape.com
Benefits Survey
Evidence-Based Medicine to Improve Patient Care
30 Moving from Utilization Management/
CAPG Member List
28 CAPG Member Spotlight: Central Ohio Primary Care
Referral Authorizations to True Population Health Management
From the President A M ES S AG E F R O M D O N A L D C R A N E , P R ES I D E N T A N D C EO , C A P G
CAPG Members and Friends: The theme of this issue of CAPG Health is Clinical Quality, a subject that reflects our purpose as an organization. It is, in fact, spelled out in the first sentence of our mission statement: The mission of CAPG is to assist accountable physician groups to improve the quality and value of healthcare provided to patients. It is why we put so much emphasis on education, exposure to the views of experts, and opportunities to share ideas with other innovative members. It is also why we often address quality in this publication, including this edition’s story by Dr. Amy Nguyen Howell on our annual Standards of Excellence™ program (see page 22).
Donald Crane, CAPG President and CEO
In the past two years, CAPG membership has grown beyond our expectations, giving us a presence in 40 states, the District of Columbia and Puerto Rico. I’m proud to say that our 200-plus members include the most successful, quality-driven physician groups anywhere. Many have been practicing risk-based accountable care for decades; others are adapting to a new reality and want to do it right. One sign of our increasing influence is the recent decision to add three new staff members to our Washington, DC, office. It first opened in 2013 with Mara McDermott as Director of Federal Affairs; she is now Vice President. Her success at establishing CAPG as a valuable resource on national healthcare matters soon made it clear that it would not be a singleperson staff for long. Congratulations, Mara.
CAPG 2016 CONFERENCE & COLLOQUIUM CALENDAR
I encourage members, and non-members, to attend one or both of our two major CAPG educational and networking events this year. Registration will soon open for the popular CAPG Annual Conference, to be held June 16-19 in San Diego. Our third CAPG Colloquium in Washington, DC, is scheduled for September 28-30. It provides unparalleled access to the views of congressional members, federal officials, and leading figures from academia and the healthcare community. For more information, please contact CAPG at 213.624.CAPG or www.CAPG.org. I hope to see many of you there. o
RESERVE YOUR SPACE IN CAPG’S SPECIAL EVENTS ISSUES:
CONFERENCE ISSUE Theme: Commercial ACOs Editorial & Advertising Due Friday, April 22
FALL 2016 / COLLOQUIUM ISSUE Theme: Healthcare Policy And Alternative Payment Models Editorial & Advertising Due Friday, August 5
DISCOUNTS AVAILABLE FOR EARLY BIRD RESERVATIONS AND CAPG MEMBERS. For editorial guidelines contact Daryn Kobata capghealth@capg.org Editorial Departments: Upcoming Events | Names in the News | Member Spotlight For Advertising Information : capghealth@gmail.com Valerie Okunami, Publisher 916-761-1853 Spring 2016
CAPG HEALTH l 7
Names in the News CAPG MEMBERS SELECTED FOR NEXT GENERATION ACO MODEL Four CAPG members were among 21 organizations chosen for the Centers for Medicare & Medicaid Services’ (CMS) new Next Generation Accountable Care Organization (NGACO) Model. MemorialCare Regional ACO, Prospect ACO CA, Regal Medical Group, and Triad HealthCare Network were among the selected organizations, which CMS noted have “significant experience coordinating care for populations of patients,” including through the Medicare Shared Savings Program (MSSP) and Pioneer ACO Model. In the NGACO model, CMS will partner with these ACOs whose provider groups are ready to accept higher levels of risk and reward. CAPG members have successfully offered valuebased care to patients for decades, including through percent of premium capitation in Medicare Advantage and various risk arrangements with commercial payers. Other CAPG members actively participating in delivery system reform in traditional Medicare are: Pioneer ACOs • Allina Health System • Monarch HealthCare ACO MSSP ACOs • Alegent Health Partners, LLC • Arkansas Health Network LLC • Cedars-Sinai • Catholic Health Initiatives / St. Luke’s Health Network • Colorado Accountable Care, LLC • Dignity Health • KentuckyOne Health Partners, LLC • Mercy ACO, LLC • Mission Health Care Network, LLC • UCLA • PrimeCare Select • ProHealth Accountable Care Medical Group, PLLC • Providence Health & Services • Rainier Health Network • St. Joseph Health Partners ACO • Tenet Health • Torrance Physicians ACO Center for Medicare & Medicaid Innovation (CMMI) Practice Transformation Grant • Bayhealth Physician Alliance • CMMI Demonstrations 8 l CAPG HEALTH
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• Sutter Health – advanced illness management (AIM) • SynerMed – Downtown Coordinated Care Clinic
IHA ANNOUNCES MY 2014 MA STARS RESULTS Numerous CAPG members were named by IHA in its Measurement Year 2014 (MY 2014) Medicare Advantage Stars (MA Stars) Results Highlights and Award Winners for California physician organizations (POs). Launched in 2011, IHA’s Medicare Five-Star Reporting of Physician Organizations program uses a subset of 13 Star measures most relevant to MA care delivery by POs. Reporting of PO-level MA Stars results enables targeted quality improvement initiatives by health plans, public recognition of high performing POs, and increased transparency through public reporting. In MY 2014, six POs attained 5-star ratings and 56 earned 4.5 stars for the quality of care provided to MA patients. More details and a full list of award winners, including 28 POs that improved overall star rating by 1 star or more, is available on IHA.org. 5-Star Awards • Kaiser Permanente Southern California Permanente Medical Group: o Antelope Valley o Panorama City o Baldwin Park o Kern County • Kaiser Permanente Northern California Permanente Medical Group, Fresno Medical Center • Heritage-Sierra Medical Group 4.5-Star Awards • Affiliated Doctors of Orange County • Bakersfield Family Medical Center/Heritage Physician Network • Choice Medical Group • Coastal Communities Physician Network • Desert Oasis Healthcare • Edinger Medical Group • Family Practice Medical Group of San Bernardino, Inc. • Greater Covina Medical Group • HealthCare Partners Medical Group • Heritage Victor Valley Medical Group • High Desert Medical Group • Kaiser Permanente Northern California Permanente Medical Group: o Diablo/Antioch Medical Centers o Fremont/San Leandro Medical Centers continued on page 32
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E V E N T S
CONTRACTS COMMITTEE CAPG ANNUAL CONFERENCE 2016: SHARING THE LESSONS OF INNOVATIVE PAYMENT MODELS Thursday to Sunday, June 16-19 Manchester Grand Hyatt, San Diego capg.org/conference2016; 213.624.2274 At CAPG’s renowned Annual Conference, gain hands-on knowledge and best practices from physician groups and IPAs that are thriving in risk arrangements, along with high-level political and legislative insights. For sponsor and exhibitor information, please contact Cassandra Perkins, cperkins@capg.org.
U P C O M I N G
NORTHWEST REGIONAL MEETING Thursday, January 21 Doubletree by Hilton Seattle Airport, Seattle
CAPG NATIONAL MEETING Friday, January 29 San Antonio Marriott Rivercenter, San Antonio
PUBLIC POLICY COMMITTEE Thursday, February 11 Conference Call
GENERAL MEMBERSHIP MEETING, SOUTHERN CALIFORNIA 8TH BIENNIAL MANY FACES OF DEMENTIA CONFERENCE
10 l CAPG HEALTH
Thursday, January 21 CAPG office, Los Angeles
Friday, February 12 USC Radisson Hotel, Los Angeles https://adrc.usc.edu/many-faces; manyface@usc.edu Conference will address the current and future direction of dementia and Alzheimer’s disease research and treatment, along with practical topics and best practices. Presented by the USC Memory and Aging Center/Alzheimer Disease Research Center and Alzheimer’s Greater Los Angeles.
VALUE-BASED PAYMENT AND PAY FOR PERFORMANCE SUMMIT Wednesday to Friday, February 17-19 Hyatt Regency, San Francisco http://www.pfpsummit.com; 800.503.7382 Leaders from all healthcare sectors, including several CAPG members, will share best practices and lessons learned in real-world implementation of valuebased payment. CAPG members receive discounted registration rates (use code CAPG).
Spring 2016
Tuesday, February 9 CAPG office, Los Angeles
PHARMACEUTICAL CARE COMMITTEE Wednesday, February 10 CAPG office, Los Angeles
GENERAL MEMBERSHIP MEETING, NORTHERN CALIFORNIA Thursday, February 11 Oakland, Hilton Oakland Airport Hotel
PRIMARY CARE PRACTICE TRANSFORMATION COLLABORATIVE Wednesday, February 24 CAPG office, Los Angeles
PUBLIC RELATIONS AND MARKETING COMMITTEE Tuesday, March 1 CAPG office, Los Angeles
PUBLIC POLICY COMMITTEE Thursday, March 10 Conference Call
STATE GOVERNMENT PROGRAMS COMMITTEE Tuesday, March 8 TBD, Sacramento
CAPG NATIONAL MEETING Tuesday, March 15 TBD, Washington
CLINICAL QUALITY LEADERSHIP COMMITTEE
COLORADO REGIONAL MEETING
Tuesday, March 22 CAPG office, Los Angeles
Thursday, April 28 Denver Marriott Tech Center, Denver
SOUTHWEST REGIONAL MEETING
MEDICARE ALTERNATIVE PAYMENT MODEL (APM) COMMITTEE
Thursday, March 24 TBD, Phoenix
TEXAS REGIONAL MEETING Thursday, March 31 TBD, Houston
PUBLIC POLICY COMMITTEE
Tuesday, May 3 WebEx
PUBLIC POLICY COMMITTEE Thursday, May 12 Conference Call
Thursday, April 14 Conference Call
GENERAL MEMBERSHIP MEETING, SOUTHERN CALIFORNIA
INLAND EMPIRE REGIONAL MEETING
Tuesday, May 10 CAPG office, Los Angeles
Tuesday, April 12 Mission Inn, Riverside
SAN DIEGO REGIONAL MEETING Thursday, April 14 TBD, San Diego
HUMAN RESOURCES COMMITTEE Tuesday, April 19 WebEx
CONTRACTS COMMITTEE Thursday, April 21 CAPG office, Los Angeles
SOUTHEAST REGIONAL MEETING Tuesday, April 26 TBD, Tampa Bay
GENERAL MEMBERSHIP MEETING, NORTHERN CALIFORNIA Thursday, May 12 Hilton Oakland Airport Hotel, Oakland
NORTHEAST REGIONAL MEETING Tuesday, May 17 Renaissance Philadelphia Airport Hotel, Philadelphia
PRIMARY CARE PRACTICE TRANSFORMATION COLLABORATIVE Wednesday, May 18 CAPG office, Los Angeles
STATE GOVERNMENT PROGRAMS COMMITTEE Tuesday, May 24 CAPG office, Los Angeles
PHARMACEUTICAL CARE COMMITTEE Wednesday, May 25 CAPG office, Los Angeles
PUBLIC POLICY COMMITTEE Thursday, June 9 Conference Call
CAPG NATIONAL MEETING Thursday, June 16 CAPG Annual Conference, Manchester Grand Hyatt, San Diego Unless otherwise noted, contact CAPG for more information on these events: 213.624.2274. Spring 2016
CAPG HEALTH l 11
ON THE COVER
CAPG Members Can Bring Positive Change to the Healthcare System BY BART ASNER, MD , C H A I R , B OA R D O F D I R ECTO R S , C A P G
In 2003, I served as the first Board Chair of CAPG. I recently accepted the opportunity to serve again as Chair because we are experiencing the most dynamic time in healthcare in the past 25 years—an unparalleled opportunity to bring muchneeded change to our healthcare system. CAPG has grown from a California “trade association” into a respected and recognized national leader in transforming healthcare, in support of the Triple Aim. Our nation seeks effective answers to healthcare cost and quality challenges. The consensus solution in Washington, DC, is coordination of care and risk-based payment reform, which means that policy makers are looking to CAPG members to lead the way! Physicians and medical groups will design a system that will provide the best care for patients, because that is what we care about—helping patients get the care they need to live healthier lives.
“
We are experiencing the most dynamic time in healthcare in the past 25 years—an unprecedented opportunity to bring muchneeded change to our healthcare system.”
I serve as Chief Executive Officer and a member of the Board of Directors of Monarch HealthCare, an Independent Practice Association (IPA) founded in 1994. Monarch comprises 2,500 physicians, 750 of whom are primary care providers, caring for 250,000 patients in Orange County and Long Beach, Calif. Monarch is proud to have been a successful Pioneer Accountable Care Organization (ACO), and will be embarking on the ensuing phase of our Medicare journey as a Next Generation ACO. In November 2011, Monarch became part of Optum, a national health services company dedicated to making the healthcare system work better for everyone. Today, the OptumCare Southern California delivery system, consisting of Monarch, AppleCare, NAMM and OptumCare Medical Group, collaborates to provide our expertise in patient care across five Southern California counties. I have the honor of serving as President of OptumCare Southern California, and I am pleased to report that our groups are working well together to reinvent care and help keep people healthy. At Monarch, we put quality care front and center. As an IPA we have developed collaborative relationships with many physician partners to improve the quality of care delivered to our patients. For example, in summer 2014, Monarch was asked by Pacific Cardiovascular Associates (PCA) to pilot a program designed to expedite outpatient cardiovascular patient evaluations after an emergency room (ER) visit for low-risk cardiac symptoms. The program, Avoiding Unnecessary Hospitalizations (AUH), aims at lowering the frequency of one-day hospital admissions, as well as Monarch’s observation stay rates. The AUH pilot, which launched in August 2014, successfully expedited care for chest pain, dysrhythmia, and other low-risk cardiac conditions by giving the patient a confirmed outpatient appointment with a cardiologist within 24 to 48 hours of an
12 l CAPG HEALTH
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ER visit. A PCA patient care coordinator was available to ER staff 24/7 to schedule the cardiology appointments, and the ER physician and patient were informed of the appointment details before discharge. A cardiologist was also available if the ER physician wanted a face-toface consultation in the ER. A Monarch medical director and PCA cardiologist held meetings with ER physician groups at two hospitals. Evidence-based guidelines were shared to reinforce with the ER physicians how best to identify chest pain patients with low risk of myocardial infarction (MI) .
Age Demographics 9% 42%
48%
The results have been positive. Sixty-six patients were diverted out of the ER to participate in the AUH program from August 2014 through October 2015. Of these:
>64 years 45-64 years <45 years
• 94% kept their scheduled appointments • 90% of the time, AUH could be credited for averting an admission, indicated by clinical review of the ER records • 74% of AUH patients received subsequent outpatient cardiac testing In summary, the AUH pilot demonstrated that patients can be safely triaged out of the ER with an expedited cardiology follow-up. The program continues, supporting the commitment by both Monarch and PCA to lower cost and provide high quality service. All of us at CAPG have a tremendous opportunity to bring similar positive change
to the healthcare system on behalf of physicians and patients. Through innovative partnerships, new ideas and strong leadership, we will create opportunities that bring real and meaningful changes for the patients who depend on us. I look forward to working with you in those efforts. o Bart Asner, MD, is President of OptumCare Southern California and CEO of Monarch HealthCare, an IPA model medical group he founded in 1994. Dr. Asner recently began his second term as Chair of CAPG’s Board of Directors for 2015-16. Special thanks to Nancy Boerner, MD, MBA, for contributing the clinical information for this article. Dr. Boerner has been Chief Medical Officer for Monarch HealthCare since 2010 and previously served in numerous other leadership roles at the group.
Spring 2016
CAPG HEALTH l 13
Policy Briefing Integrated Care for the Sickest of the Sick BY BILL BARCELLONA, SENIOR VP, GOVERNMENT AFFAIRS, CAPG
CAPG’s members serve nearly seven million Medicaid Managed Care beneficiaries, a population that ranges from healthy children, expectant mothers, adult family members, seniors, and persons with disabilities to dual eligible “medi-medi’s.” The rapid expansion of coverage for this population over the past three years has been challenging. In California, where this population is primarily concentrated, coverage has expanded to include over three million persons since 2014. Some of our members have seen enrollment swell by as much as 20,000 lives in a month. The mission to serve these individuals is laudable, yet complicated—and even, at times, frustrating. Thirty-one states have now accepted the Medicaid coverage expansion under the Affordable Care Act, providing care to persons with incomes under 138 percent of the federal poverty limit. This amount is not fixed, but is generally about $16,200 in annual income for a single person and about $33,500 for a family of four. The early data suggest that in those 31 states, overall healthcare cost trend is declining, while in the 19 non-participating states, costs continue to increase. The data support the underlying premise accepted by the Massachusetts and California legislatures in the mid-2000s that coverage expansion can lead to better cost control. As the swell of enrollment numbers subsides in 2016, the primary challenge now becomes how to address the needs of the sickest part of the beneficiary spectrum (the “super-utilizers”), yet continue to serve the broader Medicaid expansion population, which is relatively healthy compared to what some of us refer to as a “standard commercial patient population” in utilization and acuity. During CAPG’s 2015 Board Retreat, our keynote speaker, a seasoned veteran of managed care, framed the challenge more broadly, calling for two distinct networks within a network—one for the very sick and one for the generally healthy. The former should be characterized by capabilities that integrate medical, behavorial and social services into care delivery with warm handoffs and accountability. The latter is more characteristic of an easily accessible, responsive primary and preventive care system that would also manage chronic disease states in an affordable manner that keeps premiums and system costs in check. The Affordable Care Act included a pilot program under Section 2703 called Health Homes for Patients with Complex Needs. As implemented in several states, the Health Homes Program is an optional Medicaid benefit that will coordinate access to medical and behavioral health services and long-term services and support, while providing linkages to community social supports. CAPG has proposed a super-utilizer health homes model for use in Medicaid managed care programs that holds great promise for integrating services and coordinating care across the broad spectrum of medical, social services and behavioral healthcare delivery. A copy of our proposal can be downloaded from the CAPG member website. continued on page 32 14 l CAPG HEALTH
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has “CAPG proposed a superutilizer health homes model for use in Medicaid managed care programs that holds great promise for integrating services and coordinating care.”
CAPG Annual Conference 2016 Sharing the Lessons of Innovative Payment Models June 16-19, 2016 Manchester Grand Hyatt, San Diego, CA As of 2015, taking risk is no longer just an option. The Medicare Access and CHIP Reauthorization Act—MACRA—is effectively making risk mandatory for physician groups that want to stay in the game. Gain hands-on knowledge and best practices from physician organizations with successful track records in value-based care delivery, along with the big-picture view from policymakers bringing change to our healthcare system. Don’t get left behind. Register today!
Featured Sessions Include: Amitabh Chandra, PhD
Jay Gellert President and CEO, Health Net, Inc.
California’s Delegated Model: A Health Plan CEO Looks Forward
Malcolm Wiener Professor of Social Policy and Director of Health Policy Research, Harvard Kennedy School of Government
The Misspent Healthcare Dollar: Why, When, and How
Robert Berenson, MD
Scott Blakeman
Fellow, Urban Institute
Comedian and Commentator
Medicare’s Broken Fee Schedule: The Unseen Barrier to Health Care Reform
Laughter is Good for Your Health and the Healthcare Industry
Panel: Healthcare Reform Forecast Moderated by Donald H. Crane, President and CEO, CAPG
REGISTER NOW! capg.org/conference2016 Fall 2015
CAPG HEALTH l 15
Get Ready for the 2016 CAPG Survey BY S T E P H E N J . L I N ES C H , S E N I O R V P F O R A D M I N I S T R AT I O N A N D D E V E LO P M E N T, C A P G
This year will mark the 28th annual CAPG Compensation and Benefits Survey and the second year in partnership with our survey vendor Marsh & McLennan Agency (MMA). Our 2015 Compensation and Benefits Survey was notable for having 39 participants, up from 36 in 2014. This was the first increase in participation in over five years, which is significant considering recent consolidations among physician organizations and with health systems. Historically, the Survey has included 17,000 employees in 67 staff positions, more than 200 executives in 11 positions, and 1,700 physicians in 19 specialties. All data are presented for the full sample and for a number of subsets, including geographic region, participant revenue, number of employees/physicians, and organization type (IPA, MSO, medical groups, medical group/IPA). In addition, the survey provides organizational benchmarking data on a number of key productivity/performance metrics that are designed to be used to calibrate and improve staffing levels and administrative effectiveness. We strive to continuously improve the Survey so that it remains an essential tool for CAPG members, and welcome your input and recommendations. Some of our goals for 2016 include: • Metrics and questions that align with the strategic goals of CAPG members, including examining year-over-year industry trends • Implement design changes to make data entry easier and increase participation 16 l CAPG HEALTH
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• Include additional benefit and compensation metrics in the survey • Move into regional benchmarking as CAPG grows nationally The Survey input tool will be emailed in mid-April, with instructions for completion within two months. Please note that there is no cost for CAPG members to participate in the Survey, unlike some physician organizations that charge a fee. In addition, Survey results are available at no cost only to participating members. A summary of the 2016 Survey results will be presented at our Southern California General Membership/Human Resources Committee meeting, September 21 in Los Angeles, and Northern California General Membership meeting, September 22 in Oakland. Additional presentations may be scheduled. Please check our Calendar of Events on capg.org for the most current schedule. Please contact Annette Sanchez (asanchez@capg. org) or Steve Linesch (slinesch@capg.org) if your organization would like to participate in the Survey. o
In today’s value-based care world, providers need better access to data to build comprehensive and collaborative care plans to ensure quality care for their patients. Organizations partner with Allscripts to connect clinical and financial data across multiple settings into one, single source—delivering stronger insights and comprehensive, coordinated care. The Power of Partnership. That’s the Power of Allscripts.
Learn more at www.allscripts.com/value-based-care Fall 2015
CAPG HEALTH l 17
Copyright © 2015 Allscripts Healthcare Solutions, Inc.
Connect, Communicate and Collaborate Care
Federal Legislative Update CAPG Calls for Inclusion of Medicare Advantage in Delivery System Reform BY MARA MCDERMOTT, VP OF FEDERAL AFFAIRS, CAPG
In early 2015, Sylvia Burwell, Secretary of the U.S. Department of Health and Human Services (HHS), made a bold announcement outlining the goal to move Medicare away from fee-for-service and toward “alternative payment models” (APMs). A few months later, Congress enacted legislation essentially confirming the overall direction: The new Medicare Access and CHIP Reauthorization Act (MACRA) would provide incentive payments for physicians and physician organizations participating in risk-based coordinated care. Over much of 2015, the Administration and health industry stakeholders came together through the HHS Healthcare Payment Learning and Action Network (LAN). The LAN is intended to facilitate the nation’s move from volume to value— away from fee-for-service and toward APMs that enhance quality and patient satisfaction. The LAN released a framework articulating different forms of alternative payment, including the most advanced category of percent of premium capitation. Yet of great concern to CAPG members is the apparent absence of Medicare Advantage (MA) from these delivery system reform efforts. While many CAPG members receive a capitated payment from MA plans with which they contract, we know this is not the case across large swaths of the country. As CAPG continues its robust expansion nationally, we hear of many plans that are still paying fee-for-service downstream in Medicare Advantage.
EQUAL CREDIT FOR MEDICARE ADVANTAGE APMS Beginning in 2019, MACRA includes a five percent incentive payment for physicians who participate in specific APMs in traditional Medicare. To qualify for the bonus payment, the APM must meet criteria related to the type of demonstration and quality metrics, use certified electronic health records technology, and bear more than nominal financial risk or be a qualifying medical home. In addition, the physician or physician group must have at least 25 percent of their Part B revenue attributable to the APM entity. The threshold percentage goes up over time. Beginning in 2021, physicians may use their “all-payer” revenue to hit the thresholds—however, physicians and physician groups still must have 25 percent of their patients or payments in a traditional Medicare APM. This means that a physician or physician organization that is capitated in MA cannot qualify for the bonus unless they also participate in an APM in traditional Medicare. This is true even if nearly all of the physician or physician group’s revenue is in a risk-bearing arrangement in MA. continued on page 33
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reform the “Todelivery system, the same financial incentives for risk in traditional Medicare should be available for physician groups taking risk in contracts with Medicare Advantage plans.”
WITH VENTEGRA, REBATES AND TRANSPARENCY ARE A GIVEN. BUT THERE’S MORE. MUCH MORE.
You’ll find a fistful of good reasons why Ventegra is CAPG’s preferred vendor for pharmacy rebates and drugs. Rebates have always been Ventegra’s core strength. Ventegra has the largest population of groups receiving rebates, likely because we pass along 100% of all rebates and discounts. Ventegra’s proprietary Robo-RebateSM shows clearly our commitment to transparency. And for even more value added, we make it our business to stay abreast of the issues challenging our physician groups. You’ll find Ventegra’s added assets a big extra bonus: • Ventegra has a proven, turnkey solution with no upfront costs. • Our approach is efficient and easy to implement. • We monitor, anticipate and react to drug cost increases as new growth and specialty drugs emerge, actively seeking new rebate opportunities for your benefit. • Timely submissions mean prompt disbursements. • Reconciliation reports at the claims level; full transparency with no money left on the table. • On your behalf, we are always one step ahead of the game.
We not only believe in truth and integrity. We deliver it.
For your free 2016 Rebate Assessment, call Ventegra’s president, Robert T. Taketomo, Pharm.D., MBA at 858.551.8111, Ext. 109.
Ventegra, Inc., a California Benefit Corporation 450 North Brand Boulevard, Suite 600, Glendale, California 91203 858.551.8111, Ext. 109 • www.ventegra.com
Homebound Health for a Unique Population BY VALERIE GREEN-AMOS, MD, PRESIDENT, J. MARIO MOLINA, MD PROFESSIONAL CORPORATION
Recently, a JAMA Internal Medicine investigation reported that 5.6 percent of the U.S. population is homebound, including an estimated 395,422 who were completely, and 1,578, 9874 who were mostly, confined to their homes.1 With these numbers projected to continue rising, Molina Medical clinics embarked on an initiative to bring healthcare to our homebound patients in California. Our first step was to locate patients most in need of home care.
CLUES FOR FINDING CANDIDATES To pinpoint patients most in need of home treatment, we used analytics and data based on the Centers for Medicare & Medicaid Services criteria for being homebound. We also searched for those who’d been enrolled in government healthcare and assigned to our clinics but hadn’t taken advantage of their outpatient benefits for 12 months or more. The result was a list of 1,000 viable candidates–and reviewing it, we learned that our strategy for creating our initiative needed adjusting. The existing programs we’d planned to emulate catered to a different population than our own: While the others care predominantly for the elderly, Molina’s focus on Dual Eligibles means we serve a unique demographic.
THE CORRELATION BETWEEN POVERTY AND MENTAL ILLNESS Whether or not they are homebound, there’s an important medical difference between people who are under financial distress and those who are not. In the low-income population, mental disorders are twice as prevalent as they are among the middle class or wealthy.2 Among Molina patients, mental health challenges are often the driver for homebound healthcare. Our patients include 20 l CAPG HEALTH
Spring 2016
those with issues like anxiety and agoraphobia, as well as people who are disabled, chronically ill, and morbidly obese. Molina also serves the geriatric community, but as a whole, our patient population is significantly younger than those enrolled in other homebound health programs.
THE RIGHT TRAINING FOR A UNIQUE POPULATION Molina uses an individual rationale per patient, but because the overarching issue is often mental health, we employ nurse practitioners and doctors who are trained in that component, and have homebound health experience as well. Over a period of two and a half months, we built a Homebound Health team of nine nurse practitioners and two physicians. All providers on the team have experience working with elders in the home, including hospice and palliative care as well.
Molina’s Homebound Health Initiative launched in October 2014 in northern California, southern California and the Inland Empire.
SEEING RESULTS Though we did not set specific quantitative goals for this initiative, we are pleased that, in less than one year, we’ve brought care to 300 of the 1,000 patients on our list. Considering that the recognized industry standard for a viable program is a reach of 20 percent, the 30 percent we’ve been able to treat is a very promising sign. Additionally, we’ve achieved success in terms of the positive feedback our Homebound Health Initiative is getting from our patients and their families. Here’s an excerpt from just one letter that we received from the daughter of a patient: “The house call provided through the Homebound Program today was more wonderful than words can express. Dr. Mozia washed Mom’s hair, cared for her leg wounds, cleansed her face, cared for her eye and even moisturized her feet and face. We are wondering how we’ve gotten along without her and these services.”
ONWARD TO MORE HOMES In the long term, we plan to evaluate the efficacy of the program every year, and make changes and expansions as needed based on this review. If the program proves successful, we hope to expand it to our clinics in Utah and Washington. Our goal is to help as many patients as possible function at their highest capacity, feel comfortable, and maintain their independence. o http://www.ncbi.nlm.nih.gov/ pubmed/26010119, Epidemiology of the Homebound Population in the United States. 1
http://apps.who.int/iris/bitstream/ 10665/112828/1/9789241506809_eng. pdf, Social Determinants of Mental Health, Page 17 2
Spring 2016
CAPG HEALTH l 21
ORGANIZATIONAL MEMBERS Accountable Health Care IPA George M. Jayatilaka, MD, CEO Druvi Jayatilaka, Vice President
Advanced Medical Management, Inc.
M E M B E R S
Kathy Hegstrom, President
Access Medical Group/Access Santa Monica • Community Care IPA • MediChoice IPA • Premier Care IPA • Seoul Medical Group
Adventist Health Physicians Network IPA Arby Nahapetian, MD, CMO Jim Agronick, VP – IPA Operations
Affinity Medical Group
Richard Sankary, MD, President Scott Ptacnik, COO
Alameda Health Partners
William Peruzzi, MD, Chairman David Cox, Treasurer/CFO
AllCare IPA*
Matt Coury, CEO Randy Winter, MD, President
Allied Physicians of California
High Desert Medical Group
Choice Medical Group
Hill Physicians Medical Group, Inc.*
Cigna Medical Group
John Muir Physician Network
Citrus Valley Independent Physicians
Lakeside Community Healthcare
John M. Williams, PharmD., CEO Polly Chen, Director of Operations
Manmohan Nayyar, MD, President Marie Langley, IPA Administrator Edward Kim, President and General Manager Kevin Ellis, DO, CMO Gurjeet Kalkat, MD, Executive Medical Director Martin Kleinbart, DPM, Chief Strategy Officer
Colorado Permanente Medical Group, P.C.
William G. Wright, MD, Executive Medical Director Dan A. Oberg, CFO and VP Corporate Development
Conifer Health Solutions
AppleCare Medical Group, Inc.*
Alfredo Ginory, MD, CMO Gemma Rosello, Vice President
Edinger Medical Group
Matthew C. Boone, MD, Executive Medical Director Denise McCourt, Chief Operating Officer
Bakersfield Family Medical Center
Empire Physicians Medical Group*
Carol L. Sorrell, RN, COO Ju Hwan Lee, MD, Medical Director
Steven Dorfman, MD, President Yvonne Sonnenberg, Executive Director
Bayhealth Physician Alliance, LLC
Everett Clinic, P.S., The*
Bruce Swartz, SVP, Physician Integration
Adrianne Wagner, Quality Improvement Consultant Manager Shashank Kalokhe, Associate Administrator of ValueBased Contracting and Coordinated Care
John Goodman, President and CEO Charles Payton, MD, VP Medical Administration/CMO
Facey Medical Foundation*
Richard Fish, CEO Pamela Laesch, CMO
Golden Empire Managed Care, Inc.*
CareMore Medical Group
Tom Tancredi, Dir. of Practice Operations
Catholic Health Initiatives*
Don Lovasz, President, Clinically Integrated Network Chris Stanley, MD, VP of Care Management
Cedars-Sinai Medical Group*
Thomas D. Gordon, CEO Stephen C. Deutsch, MD, Chief Medical Director
Central Ohio Primary Care Physicians, Inc. J. William Wulf, MD, CEO Michael Ashanin, COO
Children’s Physicians Medical Group Leonard Kornreich, MD, President and CEO
Chinese American IPA
George Liu, PhD, President and CEO Peggy Sheng, COO
* Indicates 2015 - 2016 Board Members
22 l CAPG HEALTH
Spring 2016
Loma Linda University Health Care J. Todd Martell, MD, Medical Director
Maverick Medical Group
Warren Hosseinion, MD, Chairman Mark C. Marten, CEO
MED3000
SeaView IPA • Valley Care IPA
Marc Hoffing, MD, Medical Director Dan Frank, Chief Operating Officer
Norman Chenven, MD, CEO and Founder Kerry Rosker, Executive Administrative Coordinator
Dien V. Pham, MD, CEO Carol Houchins, Administrator
Rafael Mas, MD, SVP and CMO Julio G. Rebull, Jr., SVP
Desert Oasis Healthcare
Austin Regional Clinic
California Pacific Physicians Medical Group, Inc.
Jean Shahdadpuri, MD, MBA, CMO Varsha Desai, COO
Lynn Stratton Haas, CEO Gary Proffett, MD, Medical Director
Dignity Health
Brown & Toland Physicians*
Lakeside Medical Group, Inc. Lakewood IPA
Dean M. Didech, MD, CMO
Vinod Jivrajka, MD, President/CEO Surendra Jain, MD, CMO
Beaver Medical Group*
Jonathan Gluck, Counsel
Leon Medical Centers, Inc.
DCHS Medical Foundation
Castulo de la Rocha, JD, President/CEO Martin Serota, MD, CMO
Lee Huskins, Interim CEO/SVP/COO Ravi Hundal, MD, Medical Director
Alamitos IPA • St. Mary IPA • Brookshire IPA
Rod Christensen, MD, VP of Medical Operations Brian Rice, MD, VP Network/ACO Integration
AltaMed Health Services Corporation*
David Joyner, CEO Tom Long, MD, CMO
AKM Medical Group • Amvi Medical Group • Exceptional Care Medical Group • Family Choice Medical Group • Family Health Alliance • Huntington Park Mission Medical Group • Medicina Familiar Medical Group • New Horizon Medical Group • Noble Community Medical Associates • OmniCare Medical Group • Premier Physician Network • United Care Medical Group
Continucare Corporation
Allina Health System
Charles Lim, MD, FACP, Medical Director Anthony Dulgeroff, MD, Assistant Medical Director
Megan North, CEO
Thomas Lam, MD, CEO Kenneth Sim, MD, CFO
Evan W. Polansky, JD, Executive Director Joseph M. Parise, DO, Medical Director
C A P G
Chinese Community Health Care Association
James Slaggert, CEO Erik Davydov, MD, Medical Director Michael Myers, President and CEO Steve Bass, MD, CMO
Good Samaritan Medical Practice Association Nupar Kumar, MD, Medical Director
Greater Newport Physicians Medical Group, Inc.* Diane Laird, CEO Adam Solomon, MD, CMO
HealthCare Partners*
MedPoint Management Kimberly Carey, President Rick Powell, MD, CMO
Accountable Healthcare IPA • Bella Vista Medical Group IPA • Centinela Valley IPA • El Proyecto Del Barrio, Inc. • Global Care Medical Group • HealthCare LA IPA • Jewish Home for the Aging IPA • Pioneer Provider Network, A Medical Group, Inc. • Premier Physicians Network • Prospect Medical Group, Inc. • Redwood Community Health Network • Watts Healthcare Corporation
MemorialCare Medical Group* Mark Schafer, MD, CEO Jennifer Jackman, COO
Meritage Medical Network
Wojtek Nowak, CEO J. David Andrew, MD, Medical Director
Mid-Atlantic Permanente Medical Group, PC
Bernadette Loftus, MD, Associate Executive Director for MAS Jessica Locke, Special Assistant
Molina Medical Centers*
Keith Wilson, MD, Vice President of Clinical Services Gloria Calderon, Vice President of Clinic Operations
Monarch HealthCare*
Bart Asner, MD, CEO Ray Chicoine, President and COO
MSO of Puerto Rico
Richard Shinto, MD, CEO Raul Montalvo, MD, President
Kent Thiry, Chairman and CEO, DaVita Don Rebhun, MD, Corporate Medical Director
Muir Medical Group, IPA
Richard Merkin, MD, President Richard Lipeles, COO
NAMM California*
Heritage Provider Network*
Affiliated Doctors of Orange County • Bakersfield Family Medical Group • California Coastal Physician Network • California Desert IPA • Desert Oasis Healthcare • Greater Covina Medical Group • HealthCare Partners, IPA, AZ & NY • Heritage Physician Network • Heritage Victor Valley Medical Group • High Desert Medical Group • Priority Care Plus, AZ • Regal Medical Group • Sierra Medical Group
Ute Burness, RN, CEO Steve Kaplan, MD, President
Leigh Hutchins, President and COO T. K. Desai, MD, SVP and CMO Coachella Valley Physicians of PrimeCare, Inc., • Mercy Physicians Medical Group • Primary Care Associated Medical Group, Inc. • PrimeCare Medical Group of Chino • PrimeCare of Citrus Valley • PrimeCare of Corona • PrimeCare of Hemet Valley Inc • PrimeCare of Inland Valley • PrimeCare of Moreno Valley • PrimeCare of Redlands • PrimeCare of Riverside • PrimeCare of San Bernardino • PrimeCare of Sun City • PrimeCare of Temecula • Redlands Family Practice Medical Group, Inc.
New West Physicians, PC
St. Joseph Heritage Healthcare*
The Vancouver Clinic, Inc., P.S.
Northwest Permanente, P.C.
Hoag Medical Group • Mission Heritage Medical Group • St. Mary High Desert Medical Group
Torrance Hospital IPA
Ruth Benton, CEO Thomas M. Jeffers, MD, President and Chair Jeffrey Weisz, MD, Executive Medical Director Harry Stathos, VP and CFO
Northwest Physicians Network of Washington, LLC Rick MacCornack, CEO Scott Kronlund, MD, CMO
Omnicare Medical Group
Toni Chavis, MD, President Ashok Raheja, MD, Medical Director
The Permanente Medical Group, Inc. Oakland (North)* Michelle Caughey, MD, Associate Executive Director Suketu Sanghvi, MD, Associate Executive Director
Physicians DataTrust
Kathi Toliver, VP of IPA Administration Lisa Serratore, COO Greater Tri-Cities IPA • Noble AMA IPA • St. Vincent IPA
Physicians Choice Medical Group of San Luis Obispo John Okerblom, MD, President Barbara Cheever, Executive Director
Physicians Medical Group of Santa Cruz County Marvin Labrie, CEO Nancy Greenstreet, MD, Medical Director
C.R. Burke, CEO Khaliq Siddiq, MD, CMO
St. Vincent IPA Medical Corporation
Jeffrey Hendel, MD, President Leesa Johnson, Director of IPA Operations
San Bernardino Medical Group James Malin, CEO Thomas Hellwig, MD, President
San Diego Physicians Medical Group Joyce Cook, CEO James Cordell, MD, President
Sansum Clinic*
Pioneer Medical Group, Inc.* John Kirk, CEO Jerry Floro, MD, President
Preferred IPA of California
Santé Health System, Inc
Scott B. Wells, CEO Daniel Bluestone, MD, Medical Director
Scripps Coastal Medical Center
Anthony Chong, MD, CMO Tracy Chu, Assistant VP of Operations John Jenrette, MD, CEO Christopher McGlone, COO
Sharp Rees-Stealy Medical Group* Stacey Hrountas, CEO Alan Bier, MD, President
Southeast Permanente Medical Group, Inc., The
Michael Doherty, MD, Executive Medical Director and Chief of Staff
Southern California Permanente Medical Group*
Providence Health & Services James M. Slaggert, CEO
Providence Medical Management Services
Phil Jackson, Chief Integration and Transformation Officer Korean American Medical Group • Providence Care Network
Renaissance Physician Organization Clare Hawkins, MD, IPA Board Chair Whitney Horak, President
River City Medical Group, Inc.
Keith Andrews, MD, Medical Director Kendrick T. Que, COO
Riverside Medical Clinic
Steven Larson, MD, Chairman Judy Carpenter, President/COO
Riverside Physician Network Howard Saner, CEO Paul Snowden, COO
Keith Gran, CEO Donald Larsen, MD, CMO William Torkildsen, MD Sarah Wolf
WellMed Medical Group, P.A.
George M. Rapier III, MD, Chairman and CEO Carlos O. Hernandez, MD, President
CORPORATE PARTNERS Anthem Blue Cross of California Athenahealth Boehringer Ingelheim Pharmaceuticals, Inc. Evolent Health Humana, Inc. Merck & Co. Novartis Pharmaceuticals Novo Nordisk Patient-Centered Primary Care Collaborative Quest Diagnostics Sanofi, US SCAN Health Plan
ASSOCIATE PARTNERS
AFFILIATE PARTNERS
Summit Medical Group, PA
AMVI/Prospect Health Network • Gateway Medical Group • Genesis Healthcare • Nuestra Familia Medical Group • Pacific Healthcare IPA • Prospect Corona • Prospect HealthSource • Prospect Huntington Beach • Prospect Northwest Orange County • Prospect Orange County • Prospect Professional Care • Prospect Van Nuys
Sam Skootsky, MD, CMO Kit Song, MD, Medical Director
Swedish Medical Group
David Cooper, MD Walter LeStrange, EVP and COO Jason Barker, CEO Jeffrey Hay, MD, CMO
UCLA Medical Group*
Central Valley Medical Group • East Bay Physicians Medical Group • Gould Medical Group • Marin Headlands Medical Group • Mills-Peninsula Medical Group • Palo Alto Foundation Medical Group • Palo Alto Medical Foundation • Peninsula Medical Clinic • Physician Foundation Medical Associates • Sutter East Bay Medical Foundation • Sutter Gould Medical Foundation • Sutter Independent Physicians • Sutter Medical Foundation • Sutter Medical Group • Sutter Medical Group of the Redwoods • Sutter North Medical Group • Sutter Pacific Medical Foundation
Southwest Medical Associates
Prospect Medical Group*
Manuel Porto, MD, President and CEO Pat Dolphin, Chief Ambulatory Officer and Executive Director of University
abbvie Arkray ArroHealth Astellas Pharma US, Inc. AstraZeneca Pharmaceuticals Avenir Pharmaceuticals, Inc. Bayer HealthCare Pharmaceuticals Bio-Reference Laboratories, Inc. CVS Caremark, Corp. Daiichi Sankyo Easy Choice Health Plan, Inc. Eisai, Inc. Genentech, Inc. Genomic Health Gilead Sciences Incyte Corporation Johnson & Johnson Family of Companies Kaufman, Hall & Associates Kindred Healthcare, Inc. Lumara Health Pfizer, Inc. Ralphs Grocery Company Surgical Care Affiliates, Inc. Sunovion Pharmaceuticals Inc. Takeda Oncology The Doctors Company Vitas Healthcare Corporation of California
Vito Imbasciani, MD, Director of Government Relations James Malone, Medical Group Administrator
Mark Amico, MD, Medical Director Zahra Movaghar, Administrator
Pro Health
UC Irvine Health
Valley Organized Physicians
Graybill Medical Group • Arch Health Partners
Rosalio J. Lopez, MD, SVP and CMO Ramona Pratt, RN, COO, Group Operations
Thomas C. Wall, MD, Executive Medical Director Steve Neorr, VP, Executive Director
J. Kersten Kraft, MD, President of the Board Lori Vatcher, CEO
Santa Clara County IPA (SCCIPA)*
Physicians of Southwest Washington, LLC
PIH Health Physicians
Triad HealthCare Network, LLC
USC Care Medical Group, Inc.
Sharp Community Medical Group*
Mariella Cummings, CEO Gary R. Goin, MD, President
Norman Panitch, MD, President
Kurt Ransohoff, MD, CEO and CMO Vince Jensen, President and COO
Physicians Choice Medical Group of Santa Maria John Okerblom, MD, President Barbara Cheever, Executive Director
Mark Mantei, CEO Alfred Seekamp, MD, CMO
Robert B. McBeath, MD, President and CEO Greg Griffin, COO Jeffrey Le Benger, MD, Chairman and CEO Jamie Reedy, MD, VP of Population Health and Quality
Sutter Health Foundations & Affiliated Groups*
Jeffrey Burnich, MD, SVP and Executive Officer, Sutter Medical Network Brian Roach, President, Mills Peninsula Division of PAMF
Meena Mital, MD, Medical Director Bela Biro, Admin Director, Accountable Care Services
SynerMed*
James Mason, President and CEO George Ma, MD, Medical Director Alpha Care Medical Group • Angeles IPA • Crown City Medical Group • EHS Inland Valleys IPA • EHS Medical Group – Central Valley • EHS Medical Group – Los Angeles • EHS Medical Group – Sacramento • Employee Health Systems • MultiCultural IPA • Pacific Alliance Medical Center • Southern California Children’s Network
Tenet Healthcare
Jacob Furgatch, CEO, Coast Health Plan Services Ronald Kaufman, CMO
Aetion, Inc. Alignment Healthcare Altura Cal INDEX Children’s Hospital Los Angeles Medical Group CVHCare Global Transitional Care Honor Mills Peninsula Medical Group Nifty After Fifty Monarch LLC Pharmacyclics, Inc. PsycheAnalytics, Inc. Redlands Community Hospital Saint Agnes Medical Group SullivanLuallin Group Ventegra, LLC
Spring 2016
CAPG HEALTH l 23
10th Annual Standards of Excellence™ Survey Helps Physician Groups Deliver Transformational Change BY AMY NGUYEN HOWELL, MD, MBA, CHIEF MEDICAL OFFICER, CAPG
As we ring in the new year in 2016, we are reminded that it was a mere six years ago when the Affordable Care Act (ACA) was passed. Yet we still face challenges of quality, access and affordability of healthcare for our patients. Today, we strive to seize the opportunities in front of us to shape the care delivery model so patients become more engaged, our quality of care improves and total costs of healthcare decrease.
SOE survey “The will provide invaluable insights on your organization’s structure and risk readiness, while offering future indications of sustainability and viability.”
A year ago, Sylvia Burwell, Secretary of the U.S. Department of Health & Human Services, announced national goals of accelerating the movement away from fee-forservice payment models toward alternative payment models. The goal of moving 50 percent of Medicare payments into population-based payments by the end of 2018 is a bold one—indicating our government is ready to reward value and care coordination over volume and care duplication. Through our 10th National Standards of Excellence™ (SOE™) survey, CAPG has created an annual, comprehensive analysis of coordinated care infrastructure for accountable physician groups. This voluntary survey helps set the bar for healthcare consumers to evaluate member physician groups’ quality of care, responsive patient experience, and affordability. With each survey, CAPG’s Clinical Quality Leadership Committee adds new relevant elements of demonstrated value to set higher standards that keep pace with current healthcare demands in their regional markets. These annual changes are made in response to rising national standards and expectations of purchasers, payors and government agencies, and advance the survey to the performance level reflected by our members. This year, CAPG will administer our 10th edition of the survey, and we will announce the Elite winners at our Annual Conference on June 17, 2016, in San Diego. The Clinical Quality Leadership Committee works with the National Committee on Quality Assurance (NCQA) on the survey’s application, analysis, scoring, and review. This year’s SOE comprises six rigorous domains, with numbers 1 to 5 publicly reported: • Domain 1—Care Management Practices: Clinical system supports for quality and efficiency for population health management. • Domain 2—Information Technology: Funnel for accurate, actionable information to support clinical decisions and coordinate team-based care. • Domain 3—Accountability and Transparency: Response to the public demand for objective information regarding quality performance, patient service and regulatory compliance. • Domain 4—Patient-Centered Care: Critical components of access, convenience, cultural responsiveness and customized individual care.
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• Domain 5—Medical Group Support of Advanced Primary Care: Patient-centered medical home model and its use in revitalizing the discipline of primary care. • Domain 6— Administrative and Financial Capability: Management of complex relationships, diverse revenue streams, innovative payment alignment, and riskbased payments. I encourage every CAPG organizational member to participate in this year’s SOE program. By completing the survey, you will obtain a useful roadmap of your individual organization’s journey down the path of coordinated care and payment reform, equipping you with ideas and resources needed for the movement into alternative payment models. Additionally, SOE will provide invaluable insights on your organization’s structure and risk readiness, while offering future indications of sustainability and viability in our rapidly changing healthcare environment. At CAPG, we are dedicated to providing the highest quality and value in clinically integrated, comprehensive and coordinated healthcare for our patients and all Americans. It is my sincere hope that CAPG members find value in this year’s Standards of Excellence program. Our aim is to offer education and leadership so our members can learn from each other by sharing best practices
and lessons learned. We hope that you will inspire each other to strive for purposeful payment reform and clinical quality alignment within your organizations to deliver transformational changes locally, regionally, and nationally, and disseminate a better care delivery model to our patients. o
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Bench to Bedside: Fast Tracking Evidence-Based Medicine to Improve Patient Care BY K E N C O H E N , M D , FA C P, C H I E F M E D I C A L O F F I C E R , N E W W ES T P H YS I C I A N S
Information overload, clinical inertia, and financial conflict have coalesced to erect major barriers to both quality and efficiency when it comes to delivering coordinated, cost-effective healthcare in a timely manner. In response to this formidable challenge, New West Physicians (NWP) developed our Bench to Bedside program—bringing new, evidence-based practices and procedures into our group in a matter of weeks instead of years and simultaneously eliminating costly, ineffective care while maintaining superior levels of quality. Medical science moves forward at an astounding pace, creating over 100,000 pages of newly published research each month. Imbedded in this ocean of new science is a subset of studies that have the potential to fundamentally and positively affect quality and efficiency of care. These studies fall into the category of evidenced-based medicine (EBM). EBM, if practiced uniformly throughout an organization, has the potential to provide continuous quality improvement in all areas of medicine. Of paramount importance is prioritizing the rapid evolution of day-to-day medical practice based on the availability of high-quality, evidenced-based literature. The Achilles heel in EBM’s adoption has been the slow and erratic movement of new, high-quality medical science into daily clinical practice. This process has been observed to take as long as five years for implementation. Initiated in 1997, the NWP Bench to Bedside program has grown to become one of the linchpins of our organization, and a key factor in our ongoing success in maintaining a high-performing healthcare system while reducing cost of care. Our formula for efficient bench-to-bedside delivery is simple, yet critical. Relevant new literature for primary care and the major medical specialties is reviewed by the Chief Medical Officer (CMO). Based on this initial review, high-quality studies that possess the strength of evidence to affect current practice patterns are chosen and reviewed in detail. Study content is presented for consensus at the Medical Management Committee. This process serves as a change driver for daily practice and is implemented through several methods.
THE NEW WEST FORUM Written by the CMO for the past 20 years, the New West Forum communicates key recommendations for change in clinical practice to all NWP primary care providers, and to our narrow specialty panel when relevant. This educational publication is followed by a formal presentation at the quarterly shareholder meeting attended by providers. The New West Forum includes developments in EBM and a pharmaco-economic analysis of new pharmaceuticals outlining optimal utilization, which may include avoidance.
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“Evidence-based medicine, if practiced uniformly through an organization, has the potential to provide continuous quality improvement in all areas of medicine.”
Reduction In Utilization In 2014 Compared With Pre–Bench to Bedside Numbers
board, and screening was no longer offered to individuals age 70 and above.
Vertebroplasty
94%
Barretts’ Screening
68%
Nuclear Stress Test For Stable CAD Epidural Steroid Injections
Colon Polyp Surveillance
47%
54%
28%
Gleason 6 Prostate Cancer Active Surveillance
84%
PHYSICIAN REVIEW COMMITTEE The NWP Physician Review Committee, comprising primary care representatives and relevant specialists, is convened when an important body of EBM literature fundamentally conflicts with major practice patterns. In a collegial format, joint decisions are made regarding the development of optimal care algorithms to define new clinical practice patterns.
REFERRAL DEPARTMENT IMPLEMENTATION Changes in clinical practice are supported by the NWP Referral Department. Requests for tests, procedures, and referrals that deviate from recommended algorithms are reviewed by the referral RNs and, if the reason for the deviation isn’t clear, referred for physician review. Such requests are then either immediately approved as an exception or sent back to the provider by the CMO to discuss the specifics and, if needed, reinforce the recommendations. Overt refusal to recognize and participate in this process has the potential to result in direction of referrals away from specific physicians. The following examples illustrate the program’s benefits:
1. PROSTATE CANCER MANAGEMENT Prior to the Bench to Bedside initiative for prostate cancer, patients over age 70 were routinely screened and, when cancer was detected, more than 70 percent of these patients chose active treatment. However, significant EBM-indicated screening for prostate cancer beyond age 70 did not improve outcomes and greatly increased costs and patient morbidity. With consensus from the narrow urology specialty network, we stopped screening at age 70 at both the primary care and specialty (urology) care levels. We also communicated our prostate screening concerns to the local Health Fair
A sound evidence base supports that most Gleason 6 prostate cancers are not aggressive and can be managed with active surveillance. Nationwide, less than 50 percent of patients with Gleason 6 prostate cancer are managed in this way. In our population of these patients, 84 percent are managed with active surveillance.
2. BARRETT’S ESOPHAGUS MANAGEMENT Historically, the incidence of malignancy with Barrett’s esophagus was thought to be in the 3 percent range. Recent high-quality population studies have redefined that risk at about 0.2 percent. Moreover, no prospective outcomes studies have shown improved survival of esophageal cancer utilizing a Barrett’s esophagus screening strategy. A conservative estimate of the cost to find one case of esophageal cancer with screening is $750,000, about tenfold higher than the accepted quality-adjusted life year (QALY) for a screening procedure. Nonetheless, current practice is to screen these patients with upper endoscopy at intervals from one to three years. Implementing our revised protocol, we developed a consensus with our gastrointestinal colleagues that nondysplastic Barrett’s would be screened no more frequently than every five years.
3. VERTEBROPLASTY AND KYPHOPLASTY FOR OSTEOPOROTIC COMPRESSION FRACTURES Two prospective, randomized, controlled studies of vertebroplasty and kyphoplasty versus a sham procedure were published. Neither study showed any benefit to the procedure. Within 12 weeks of these publications, our approach cut the use of both procedures among our population by over 90 percent.
4. INTRACRANIAL STENTING FOR TRANSIENT ISCHEMIC ATTACK/STROKE DUE TO INTRACRANIAL STENOSIS Two well-designed studies, including a March 2015 study published in the Journal of the American Medical Association, showed significantly worse outcomes for elective intracranial stenting versus optimal medical therapy, with higher rates of both stroke and intracranial hemorrhage in the intervention group. Our group subsequently issued a moratorium on this procedure until high-quality studies supporting improved outcomes with continued on page 34 Spring 2016
CAPG HEALTH l 27
CAPG Member Spotlight Central Ohio Primary Care CAPG Health caught up with Dr. Bill Wulf, CEO of Central Ohio Primary Care (COPC), to learn more about the organization and its progress on the journey to risk-based coordinated care. CAPG: The nation’s physician groups are moving from a volume-based delivery system to a value-based. Where is COPC in its transition to “alternative payment models” and value-based care delivery? Dr. Wulf: COPC began its value journey with an investment in the patient-centered medical home (PCMH). Philosophically, we saw the PCMH model as a way to begin to bring
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together a number of unique physician offices, unite our physicians around common clinical measures, and ensure better access to high quality care. COPC was able to leverage existing relationships with health plans in our market to invest in the PCMH model. Our local payers made a financial commitment to the model and our physician group committed to build the PCMH capacity and infrastructure. Over a relatively short period of time, we saw that the PCMH model was both improving the care offered to our patients and bending the cost curve. At that point, we were able to negotiate an upside-only shared savings arrangement with health plans. Today, our physicians receive shared savings payments, a care coordination fee, and their fee-for-service reimbursement for improving quality and lowering cost in the PCMH model.
CAPG: How have your physicians responded to the move to the PCMH and shared savings model? Dr. Wulf: Our physicians view the movement to a socalled alternative payment model as an investment in the health of our patients. To date, they’ve demonstrated strong commitment to this path in different ways. As one example, many of our physicians earned incentive payments for being meaningful users of electronic health records technology. Our physicians made the determination that instead of keeping those funds individually, they would assign those payments back to the group to allow COPC to invest in its population health capabilities. COPC was then able to use those meaningful use dollars to expand our existing Transitions of Care (TOC) nursing program, which aids patients who are leaving the hospital either for their home or another setting. If a patient is admitted to the hospital, the TOC nurse sees the patient on the first day of the stay and manages the transition out of the hospital. The TOC nurse electronically sets up an appointment with the primary care physician before the patient leaves the hospital. The nurse contacts the patient 48 hours after discharge to check on the patient’s status, reconcile medications, and remind her or him of the appointment with the primary care physician. If the patient misses the appointment with the PCP, the TOC nurse will follow up with the patient. Our physicians and patients have benefited from the commitment to our model. While this is one example, we know that much more can be done. COPC looks forward to learning from other CAPG member groups about care improvement techniques and payment methodologies that support population health. CAPG: The Transitions of Care program clearly has a direct benefit to your patients in terms of creating a smooth transition out of the hospital and back to the home. Are there other examples you’d like to share about how COPC has improved care for its patients? Dr. Wulf: One of the areas where we have been able to make significant strides for patients is in reducing unnecessary hospital readmissions. For one of our Medicare Advantage contracts, we were able to reduce the readmissions rate to about two percent (compared to a national fee-for-service Medicare rate of 18 percent). In addition, COPC has put into place a number of education programs for our patients. One of these is
a diabetes program that educates 1,200 diabetics per year. We have four full-time diabetic educators teaching 11 classes per week. This program has resulted in far better outcomes for our diabetic patients. Another example is our asthma and COPD education program. As an example, pediatric asthma patients and their parents meet with an asthma educator for 90 minutes. As a result, we’ve reduced emergency room visits and steroid use by 50 percent. COPC has also improved access and lowered costs by opening both adult and pediatric Same Day Centers that function as the urgent care facilities for our patients. This allows for after hours and weekend care for our patients by a COPC physician within our EHR. CAPG: What’s next for COPC on the journey from volume to value? Dr. Wulf: While we’ve made a lot of progress with shared savings, we know there’s more we can do and that we’re still in the early phases of our move to risk. We’ve seen increasing levels of success over the past couple of years in shared savings. Building on this success with shared savings, our physicians are more willing to take downside risk. We’re looking to take on more risk, beginning with our Medicare Advantage relationships over the next couple of years. One of the reasons we joined CAPG was to learn from physician groups across the country and particularly on the West Coast with experience with taking financial risk. While we’re at the outset of our journey, many of the CAPG members have been engaged in these initiatives for decades. We joined CAPG to learn from what others have done and to hear from those with decades of experience in risk-based contracts. Central Ohio Primary Care (COPC) is the largest physician-owned primary care medical group in the country. COPC has over 300 providers in 55 practice locations throughout central Ohio. In the mid-1990’s, 11 practices consisting of 33 physicians came together to form a single group, COPC. The practices, facing many of the same challenges facing physicians today, sought to improve quality, enhance access to care, and consolidate administrative functions into a single group. The new entity had better capabilities for patient care and greater strength in contracting with health plans. o
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Moving from Utilization Management/ Referral Authorizations to True Population Health Management: Time to Make the Transition BY TAW N YA B O S KO , D H A , M S , M H A , M S H L , A N D M EG A N C A L H O U N , M S , M S W , G E H E A LT H C A R E C A M D E N G R O U P
Historically, many organizations managing care in a risk-bearing structure such as independent practice associations, medical groups, or related enabling entities such as management services organizations have primarily concentrated on utilization management, referral authorization, and claims processing, with attention to cost containment and ensuring all compliance standards are met. These functions have served as an “operational core,” focused on getting the job done and meeting necessary requirements. As they evolve, these organizations realize that simply “getting it done” will not suffice; they need to increase the focus on the clinical delivery process in order to affect the health outcomes of their populations. Star ratings, publicly reported outcomes, and other performance expectations that hinge on true clinical redesign and patient engagement require a much more robust approach to population risk management. This must be done while still focusing on the historic methods of cost containment and meeting regulatory and contractual requirements. The provision of more efficient, high-quality care is the expectation, not the exception. Organizations that are able to step back from routine operations and creatively define new, efficient routes to overall population health management and engagement will set the tone for the future. As healthcare delivery and payment models transform to value-based care delivery, the medical management model must evolve to meet this demand. Risk-bearing structures must become more integrated, support greater standardization and efficiency, and drive improved value in the care delivered. A cultural transformation is at the center of the new reality of healthcare. By focusing on intradepartmental collaboration and clinical integration, organizations can encourage all departments to share accountability for utilization and performance outcomes as a result of aligned incentives across providers, care team members, and administrators. Medical management departments can support continued growth by evaluating staffing and system deployment to ensure they are utilized to their maximum ability and license. Plus, administrative staff can be utilized as intermediaries between patients and clinical staff when clear escalation protocols are established. Organizations often need to reorganize, retrain, and redeploy existing staff to improve efficacy and create a scalable model. Historically, utilization management and care management functions have been implemented primarily to monitor the approval of services based on medical necessity. Today, organizations are being asked to develop more robust clinical services that manage cohorts of patients across care settings and among providers — calling for clinical services staff to be allocated according to established member ratios and need, and processes defined for patient follow-up, care planning, and evidence-based interventions. Processes must be optimized for greatest efficiency and standardized to leverage existing technology and analytics capabilities, while workflows are communicated 30 l CAPG HEALTH
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organization-wide to allow for the sharing of best practices. As organizations pursue this transition, they will face numerous challenges that may hinder their progress. Reprioritizing the focus of managed care operations from referral management to care model redesign is a challenge to many “imbedded” operating structures. Organizations often shy away from upsetting physicians with performance transparency or information technology changes, yet these disruptions may be necessary to achieve true care model reform. While physicians feel as though they are constantly being asked to do more, the onus for improved care outcomes ultimately falls on their shoulders. Engaging physicians in the processes rather than operating in an “us versus them” structure will help guide the future direction of population health management. A lack of education or understanding regarding population health principles throughout all levels of the organization can also prevent the necessary cultural and clinical transformation, as care management processes may be focused on reduced healthcare utilization rather than the provision of care for populations of patients. Strong clinical and operational leadership must be in place and work in tandem to achieve the desired clinical outcomes. Organizations have historically utilized their physician leadership to review authorizations — such a role must now expand to integrate referral processing with care, disease, quality and outcomes management oversight. Identifying the resources to lead clinical services in this manner is a difficult task. As these organizations continue to grow and expand the role of their clinical operations, processes must be data-driven, providing actionable insights in a timely manner to propel improvement. Organizations without advanced analytic capabilities may have difficulty implementing performance improvement initiatives and enhancing care for their population. Success will rely on designing processes around the health outcomes of populations, integrating
care across the continuum and developing clinical leadership. In this rapidly changing environment, highperforming physician networks must not only think and behave like payers in many respects but also improve on existing referral and care management processes and structures. The goal: to move beyond a silo mentality, understanding that the activities of each department and care setting are interconnected and must function as a cohesive unit to support population health management initiatives. The unprecedented shift of financial risk from payers to providers is occurring because providers are in the best position to control healthcare costs and improve overall value. However, simply following traditional payer processes will not radically change the delivery system. Aligning clinical operations with financial performance indicators and a strong, well-managed and engaged provider network will enable future success. So will thinking beyond the walls of traditional providers and extending care to include social support and other community services, along with the use of new tools and technology. Existing risk-bearing organizations and enablement companies must streamline and refocus population health management functions to align with current market expectations and requirements of success. Simply repeating the processes already or previously conducted by payers is not sufficient. Provider organizations have an advantage over payers in being best positioned to improve healthcare value — reducing cost and improving quality. Achieving this will take visionary clinical leadership, care model redesign, well-defined operational processes, integration with nontraditional healthcare providers and engagement of the entire healthcare team. o Tawnya Bosko, DHA, MS, MHA, MSHL, is Vice President, GE Healthcare Camden Group, Tawnya. Bosko@ge.com. Megan Calhoun, MS, MSW, is a senior consultant, GE Healthcare Camden Group, Megan.Calhoun@ge.com.
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Names in the News...continued from page 8
4.5-Star Awards o Modesto/Manteca/Stockton Medical Centers o Oakland/Richmond Medical Centers o Redwood City Medical Center o Roseville/Sacramento Medical Centers o San Francisco Medical Center o San Jose Medical Center o San Rafael Medical Center o Santa Clara Medical Center o Santa Rosa Medical Center o South Sacramento Medical Center o South San Francisco Medical Center o Vallejo/Vacaville Medical Centers • Kaiser Permanente Southern California Permanente Medical Group: o Downey o San Diego o Fontana/Ontario o South Bay o Los Angeles o West Los Angeles o Orange County o Woodland Hills o Riverside • Lakeside Medical Organization • Mercy Medical Group/Dignity Health Medical Foundation • Palo Alto Medical Foundation - Mills-Peninsula Division/ Mills-Peninsula Medical Group • Palo Alto Medical Foundation - Sutter Health • Physician Associates of the Greater San Gabriel Valley • PIH Health Physicians - Group Division • Pomona Valley Medical Group • Premier Healthcare • Primary Care Associates Medical Group • Regal Medical Group • San Jose Medical Group • Sansum Clinic • Scripps Clinic Medical Group • Sharp Rees-Stealy Medical Group
Policy Briefing...continued from page 14
The CAPG proposal, which has been shared with state officials in California and Centers for Medicare & Medicaid Services officials in Washington, DC, proposes to create 50 copies of two successful clinic models formed in San Diego and Los Angeles. The San Diego pilot, which was staffed by the MultiCultural Independent Practice Association, obtained its seed funding from an innovations grant by the Center for Medicare & Medicaid Innovation.
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• St. Jude Heritage Medical Group • St. Mary’s High Desert Medical Group • Sutter East Bay Medical Foundation • Sutter Medical Group • Sutter Medical Group of the Redwoods • UC Davis Medical Group • UC San Diego Health System • Woodland Healthcare PSW NAMES MELANIE MATTHEWS AS NEW CEO The managing board of Physicians of Southwest Washington has named Melanie Matthews as the independent physicians association’s new CEO, effective February 1. She succeeds longtime CEO Mariella Cummings, who retires March 1. “Melanie brings her personal capacity for energy, clear focus and performance excellence to our already successful management team,” said PSW Managing Board President Dr. Gary Goin. “In addition, her nationally recognized visionary leadership will assure that PSW continues its work to help integrate the ideas of healthcare reform into the lives of our patients and the practices of our physicians.” Matthews brings 20 years of healthcare experience in areas including financial management, operations, human resources, and system development. Most recently she served as vice president of operations at Prestige Care, Inc., overseeing regulatory and financial operations and outcomes for 38 skilled nursing facilities and two Medicare home health agencies in four states. The chair of the Washington Health Care Association, Matthews was appointed a National Political Ambassador by the American Health Care Association in 2013, and a national Future Leader in 2012. She holds an MS in social gerontology from Central Missouri State University and a bachelor’s degree from Pennsylvania State University. o
During its pilot phase, the clinic successfully integrated care delivery for super-utilizer patients across the social services, medical and behavioral health spectrum. The clinic model improved care and saved $8,000 in costs per patient over the course of the pilot. Local San Diego providers have now formed a foundation to continue funding the clinic beyond the pilot phase, creating a sustainable business model for this project. CAPG continues to work with officials to develop the superutilizer clinic model, and we look forward to helping our members proliferate this important new form of access for Medicaid beneficiaries. o
Federal Update...continued from page 18
We strongly recommend this threepronged approach to adoption of more equitable Medicare Advantage APMs: One: Create a Single Medicare Threshold. Rather than a Medicare Part B threshold, we are encouraging lawmakers and regulators to consider a Medicare threshold that would include both traditional and Medicare Advantage. MA contracts that use comparable criteria to those set forth for eligible APMs in traditional Medicare should count toward achievement of the Medicare threshold. Organizations that satisfy this Medicare threshold would qualify for the five percent bonus on their Medicare Part B revenue. Two: Create an MA Incentive for Physician Groups. To reform the delivery system, the same financial incentives for risk in traditional Medicare should be available for physician groups taking risk in their contracts with MA plans. For a group that participates in MA, the APM incentive should apply to the groupâ&#x20AC;&#x2122;s MA revenue, not just the Medicare Part B revenue. This incentive should be paid directly to the physician or physician group taking the risk. CAPG is recommending a structure parallel to MACRAâ&#x20AC;&#x201D;once a physician organization exceeds certain thresholds for risk in Medicare, the bonus should apply to MA revenue for physician services. The amount of the bonus should be adjusted to account for the financial incentives to health plans in prong three. Three: Create an Incentive for Health Plans Financial incentives should be made available to health plans that enter risk-bearing arrangements with physician organizations. With increasing frequency, CAPG hears from its members that many health plans are reluctant to offer risk-bearing arrangements to capable physician organizations. We believe that an incentive for health plans to pursue and enter such relationships would accelerate delivery system reform.
WHAT CAN CAPG MEMBERS DO? Achieving these types of changes will require a significant advocacy effort. CAPG will continue to advance this three-pronged strategy in Washington, DC. We encourage our members to incorporate this messaging in their own advocacy with the agency and with members of Congress. As the Centers for Medicare & Medicaid Services works to implement MACRA, and as Congress turns its attention to strengthening the MA program, there will be opportunities to advance this message. Together, we can enhance the physician voice promoting the importance of Medicare Advantage to an advanced delivery system. o
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Bench to Bedside...continued from page 27
this procedure are published or unless the procedure involved patient participation in a randomized clinical trial. Furthermore, since optimal medical therapy is superior to invasive therapy for intracranial stenosis, there is rarely an indication for expensive computed tomography angiography and magnetic resonance angiography diagnostics to evaluate for intracranial stenosis; most of these are no longer performed. The fundamental determinants of quality, patient service, and cost efficiency ultimately flow from the physician’s pen—making physician centricity the foundation of a high-functioning healthcare system. At the primary care level, our providers view themselves as better physicians as a result of the process, continually raising the bar of daily practice. Also, as the compensation model is significantly weighted towards both quality and efficiency measures, the providers view this as important to their practice financial success. Within our narrow specialty network, the response to our Bench to Bedside program and EBM efforts has been interesting. The specialist physicians recognize
that this process “holds their feet to the fire” of EBM and mandates an optimal approach to patient care. Their practice patterns are scrutinized by peers in a way not seen before. Adopting this approach, our organizational mission is to move from bench to bedside in 12 weeks, compared to the historical observed delay of up to five years. As a result, patients receive optimal evidence-based care with improvements in outcomes, decreased morbidity, and decreases in per capita healthcare costs. Overall, there has been broad support for this approach across both primary care and specialty care providers. Many innovations required to reach high-performing healthcare system attributes involve expensive additions in case management staff and/or IT infrastructure. However, the bench-to-bedside/EBM approach not only has been inexpensive to implement, it yields additional benefits: It is easily scalable across organizations, quickly defines the optimal providers in a marketplace, and provides incentives for others to reach that bar. Most importantly, it simultaneously improves quality and efficiency as it ultimately reduces costs. o
SAVE THE DATE!
CAPG Colloquium 2016 September 28-30, 2016
Hyatt Regency on Capitol Hill Washington, DC
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More than 1 million prescriptions to date1*
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Learn more and register for updates at INVOKANAhcp.com
*Data on file. Based on TRx data sourced from IMS NPA Database, weekly data through 6/6/14. † The Savings Card is not available to patients enrolled in federally subsidized healthcare programs that cover prescription drugs, including Medicare, Medicaid, TRICARE, or other federal or state programs.
>> Subject to a $3,900 maximum annual benefit, 12 months after activation or 12 uses, whichever comes first >> Continuing support may also be available for eligible patients who have exhausted their 12 months in the program >> For eligibility requirements and restrictions, visit INVOKANACarePath.com or call 1-877-INVOKANA (1-877-468-6526) Reference: 1. Data on file. Janssen Pharmaceuticals Inc., Titusville, NJ.
Janssen Pharmaceuticals, Inc. Canagliflozin is licensed from Mitsubishi Tanabe Pharma Corporation. © Janssen Pharmaceuticals, Inc. 2014
September 2014
019651-140807
Clinical Quality for Positive Patient Results In the era of value-based care, clinical quality is becoming increasingly more important to achieving positive population health outcomes. Brown & Toland Physicians is committed to providing innovative clinical services to help our doctors achieve this goal. In 2015, Brown & Toland’s care managers reached out to patients after acute admissions and Emergency Department visits, resulting in reduced hospital admissions. The Care Management team of registered nurses and social workers counseled patients to ensure they received their post-admission medications and scheduled follow-up doctor appointments. The team also intervened — when necessary — to provide medical equipment or home health services on the patient’s behalf. These efforts have helped Brown & Toland achieve improved quality outcomes, lower health care costs and receive additional industry recognition. By joining with health plan and hospital partners, government organizations and employers, to coordinate care and improve quality, Brown & Toland is helping to deliver higher quality, connected and cost-effective care. In turn, our doctors are able to deliver the right care in the right setting and improve clinical patient outcomes. To learn more about Brown & Toland Physicians, visit us at brownandtoland.com.
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